Provider Demographics
NPI:1467402305
Name:STUKA, ANDREW J (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:STUKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1491
Mailing Address - Country:US
Mailing Address - Phone:570-655-2959
Mailing Address - Fax:570-655-9213
Practice Address - Street 1:1701 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1491
Practice Address - Country:US
Practice Address - Phone:570-655-2959
Practice Address - Fax:570-655-9213
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003170L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003089OtherFIRST PRIORITY HEALTH
PA101523OtherFIRST PRIORITY LIFE INSURANCE
PA0006705810001Medicaid
PA101523OtherHIGHMARK BLUE SHIELD
PA101523OtherFIRST PRIORITY LIFE INSURANCE
PA101523XNXMedicare PIN